Ginsburgs Early Diagnosis Of Pancreatic Cancer Helps Prognosis
Specialists in pancreatic cancer from the Mayo Clinic to the University of California labeled her tumors small size, accidental discovery and her lack of symptoms as “lucky” breaks that offer a measure of hope.
Ginsburgs cancer was discovered during her annual checkup in late January and a CAT scan revealed a tumor in the center of the pancreas, about 1 centimeter in width, according to information released by the court. That would classify the cancer as early, stage zero to 1A, the American Cancer Society said on its Web site. Ginsburg, 75, was operated on at Memorial Sloan- Kettering Cancer Center in New York City.
When surgery removes an early-stage pancreatic cancer, patients have a much better prognosis. If doctors can remove all the cancer tissue, “the hope is that the disease is cured,” said Austin Duffy, medical oncologist at the National Cancer Institute, yesterday in an interview.
Cancer of the pancreas struck 37,680 people and killed 34,290 in the U.S. in 2008. It is treated with surgery, radiation and combination chemotherapy, which have eked out small steady gains in the diseases otherwise grim course. About 37 percent of those diagnosed at stage zero to 1A survive at least five years, according to the cancer society.
The court did not say whether Ginsburg had an adenocarcinoma, the most common kind of pancreatic cancer that is fast-growing and gives the disease its virulent reputation as one of the most deadly forms of cancer. The median length of survival for adenocarcinoma patients of all stages is about 8.5 months, according to the cancer society.
Early Stage Detection
For most patients, the disease often is large and spread into the abdomen before its found. Few people are diagnosed at an early stage because the cancers location makes it hard to identify until it is advanced. The pancreas gland is buried deep in the abdomen between the stomach and spine, liver, intestine and other organs.
Ginsburg will probably stay in the hospital seven to 10 days, the court said, citing the attending surgeon, Murray Brennan. Memorial Sloan-Kettering declined to comment beyond the courts statement and did not make Brennan available.
Whipple Procedure
Doctors can cure some pancreatic cancer patients with an operation called a Whipple procedure. This surgery involves removal of the pancreas, a portion of the small bowel and part of the stomach.
The operation generally takes six to 10 hours and patients often have a difficult recovery period. While a Whipple is the standard procedure for removing pancreatic cancer, surgeons sometimes can excise small tumors in a smaller, more conservative operation.
“We take hope in reports that this was apparently an early stage of disease, and wish her well, offer our support and prayers, and want to encourage her in what we know is going to be a challenging course of therapy,” said Otis Brawley, the cancer societys chief medical officer, yesterday in a statement.
Variables Affect Prognosis
The outlook for Ginsburgs case depends on several questions: the tumors cell type, whether the margins around the tumor were clear of stray cancer cells, and whether the lymph nodes near the pancreas were free of cancer. Answers would fine- tune her prognosis and treatment.
“If it was truly incidental, if it was an adenocarcinoma, and the margins are clear, and the lymph nodes are negative, then shes in a dramatic minority of patients, and she has a reasonably good chance of survival,” said Alan P. Venook, associate chief, division of clinical oncology at the University of California, San Francisco. He isnt involved in her care.
Ginsburgs case is so rare that it discourages speculation about her prognosis by anyone but her surgical team.
“I cant give you numbers because we never find cancers of this sort. This is a fluke. Is there a data set that tells me how likely she is to be cured of with surgery alone? No, because it only happens by the weirdest of circumstances,” said Venook.
“In any case, shes very lucky, potentially,” he said.